{"title":"如何区分胃食管反流性慢性咳嗽中ppi难治性和ppi反应性患者：反流后吞咽诱发的蠕动波指数和平均夜间基线阻抗提供了新的预测因素。","authors":"Wanzhen Li, Bingxian Sha, Haodong Bai, Tongyangzi Zhang, Shengyuan Wang, Yadav Ambedkar Kumar, Yiqing Zhu, Li Yu, Xianghuai Xu","doi":"10.1183/23120541.00299-2024","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>The results of empirical trials with proton pump inhibitors (PPIs) for management of gastro-oesophageal reflux-induced chronic cough (GERC) have resulted in considerable controversy, and the mechanism of PPI refractoriness remains unclear. Our study aims to identify the predictors of PPI refractoriness of GERC in a retrospective clinical study.</p><p><strong>Methods: </strong>In total, 128 GERC patients were enrolled between March 2018 and October 2022. Regression analysis was utilised to create a model for predicting PPI-refractory of GERC using retrospective analysis of the general data and MII-pH indicators.</p><p><strong>Results: </strong>The post-reflux swallow induced peristaltic wave index (PSPWI) was lower in the PPI-refractory group than the PPI-responsive group (33.89±7.38 <i>versus</i> 39.45±9.47, respectively, p<0.001), as were the mean nocturnal baseline impedance (MNBI) and proximal MNBI (2092.11 (IQR: 652.23)] <i>versus</i> 2426.52 (IQR: 917.39) Ω, respectively, p=0.012; 1599.50 (IQR: 1206.63) <i>versus</i> 2274.50 (IQR: 1775.29) Ω, respectively, p=0.001). Multivariate logistic regression analysis identified the PSPWI (odds ratio 0.919, p=0.001) as an independent predictor of PPI-refractory GERC.</p><p><strong>Conclusions: </strong>The diagnostic value of both proximal MNBI ≤39.90% and MNBI ≤2233.58 Ω had moderate sensitivity (71.67%) and specificity (75.00%) to identify PPI-refractory GERC.</p>","PeriodicalId":11739,"journal":{"name":"ERJ Open Research","volume":"11 1","pages":""},"PeriodicalIF":4.3000,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11744322/pdf/","citationCount":"0","resultStr":"{\"title\":\"How to distinguish PPI-refractory from PPI-responsive patients in gastro-oesophageal reflux-induced chronic cough: post-reflux swallow induced peristaltic wave index and mean nocturnal baseline impedance provide new predictive factors.\",\"authors\":\"Wanzhen Li, Bingxian Sha, Haodong Bai, Tongyangzi Zhang, Shengyuan Wang, Yadav Ambedkar Kumar, Yiqing Zhu, Li Yu, Xianghuai Xu\",\"doi\":\"10.1183/23120541.00299-2024\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>The results of empirical trials with proton pump inhibitors (PPIs) for management of gastro-oesophageal reflux-induced chronic cough (GERC) have resulted in considerable controversy, and the mechanism of PPI refractoriness remains unclear. Our study aims to identify the predictors of PPI refractoriness of GERC in a retrospective clinical study.</p><p><strong>Methods: </strong>In total, 128 GERC patients were enrolled between March 2018 and October 2022. Regression analysis was utilised to create a model for predicting PPI-refractory of GERC using retrospective analysis of the general data and MII-pH indicators.</p><p><strong>Results: </strong>The post-reflux swallow induced peristaltic wave index (PSPWI) was lower in the PPI-refractory group than the PPI-responsive group (33.89±7.38 <i>versus</i> 39.45±9.47, respectively, p<0.001), as were the mean nocturnal baseline impedance (MNBI) and proximal MNBI (2092.11 (IQR: 652.23)] <i>versus</i> 2426.52 (IQR: 917.39) Ω, respectively, p=0.012; 1599.50 (IQR: 1206.63) <i>versus</i> 2274.50 (IQR: 1775.29) Ω, respectively, p=0.001). Multivariate logistic regression analysis identified the PSPWI (odds ratio 0.919, p=0.001) as an independent predictor of PPI-refractory GERC.</p><p><strong>Conclusions: </strong>The diagnostic value of both proximal MNBI ≤39.90% and MNBI ≤2233.58 Ω had moderate sensitivity (71.67%) and specificity (75.00%) to identify PPI-refractory GERC.</p>\",\"PeriodicalId\":11739,\"journal\":{\"name\":\"ERJ Open Research\",\"volume\":\"11 1\",\"pages\":\"\"},\"PeriodicalIF\":4.3000,\"publicationDate\":\"2025-01-20\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11744322/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"ERJ Open Research\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1183/23120541.00299-2024\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/1/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q1\",\"JCRName\":\"RESPIRATORY SYSTEM\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"ERJ Open Research","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1183/23120541.00299-2024","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/1/1 0:00:00","PubModel":"eCollection","JCR":"Q1","JCRName":"RESPIRATORY SYSTEM","Score":null,"Total":0}
引用次数: 0
摘要
背景：质子泵抑制剂（PPI）治疗胃食管反流性慢性咳嗽（GERC）的实验结果引起了相当大的争议，PPI难治性的机制尚不清楚。我们的研究旨在通过回顾性临床研究确定GERC的PPI难治性的预测因素。方法：2018年3月至2022年10月，共纳入128例GERC患者。通过对一般数据和MII-pH指标的回顾性分析，采用回归分析建立预测GERC ppi难治性的模型。结果：ppi难治性组胃食管反流后吞咽诱导的肠蠕动波指数（PSPWI）低于ppi反应性组（33.89±7.38 vs 39.45±9.47），分别为2426.52 （IQR: 917.39） Ω， p=0.012；1599.50 （IQR: 1206.63) vs 2274.50 （IQR: 1775.29） Ω， p=0.001）。多因素logistic回归分析发现PSPWI（比值比0.919,p=0.001）是ppi难治性GERC的独立预测因子。结论：近端MNBI≤39.90%和MNBI≤2233.58 Ω对ppi难治性GERC的诊断价值均为中等敏感性（71.67%）和特异性（75.00%）。
How to distinguish PPI-refractory from PPI-responsive patients in gastro-oesophageal reflux-induced chronic cough: post-reflux swallow induced peristaltic wave index and mean nocturnal baseline impedance provide new predictive factors.
Background: The results of empirical trials with proton pump inhibitors (PPIs) for management of gastro-oesophageal reflux-induced chronic cough (GERC) have resulted in considerable controversy, and the mechanism of PPI refractoriness remains unclear. Our study aims to identify the predictors of PPI refractoriness of GERC in a retrospective clinical study.
Methods: In total, 128 GERC patients were enrolled between March 2018 and October 2022. Regression analysis was utilised to create a model for predicting PPI-refractory of GERC using retrospective analysis of the general data and MII-pH indicators.
Results: The post-reflux swallow induced peristaltic wave index (PSPWI) was lower in the PPI-refractory group than the PPI-responsive group (33.89±7.38 versus 39.45±9.47, respectively, p<0.001), as were the mean nocturnal baseline impedance (MNBI) and proximal MNBI (2092.11 (IQR: 652.23)] versus 2426.52 (IQR: 917.39) Ω, respectively, p=0.012; 1599.50 (IQR: 1206.63) versus 2274.50 (IQR: 1775.29) Ω, respectively, p=0.001). Multivariate logistic regression analysis identified the PSPWI (odds ratio 0.919, p=0.001) as an independent predictor of PPI-refractory GERC.
Conclusions: The diagnostic value of both proximal MNBI ≤39.90% and MNBI ≤2233.58 Ω had moderate sensitivity (71.67%) and specificity (75.00%) to identify PPI-refractory GERC.
期刊介绍：
ERJ Open Research is a fully open access original research journal, published online by the European Respiratory Society. The journal aims to publish high-quality work in all fields of respiratory science and medicine, covering basic science, clinical translational science and clinical medicine. The journal was created to help fulfil the ERS objective to disseminate scientific and educational material to its members and to the medical community, but also to provide researchers with an affordable open access specialty journal in which to publish their work.
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